What’s Old Is New Again At Bridgepoint Active Healthcare

by Sara Marberry | October 23, 2013

Designing a new hospital is always a complex process. In Canada, it’s even more complicated because, historically, new facilities have been paid for by the government and require a different type of approval process than in the U.S. Bridgepoint Active Healthcare's new Bridgepoint Hospital, a healthcare and rehabilitation facility in Toronto that opened last June, is no exception.

More than a dozen years in the making and designed and built on a historic site, the project required two teams of architects that were responsible for a two-tiered design and delivery program. Not only does the dramatic building represent a new model for healthcare and rehabilitation in Canada, but it also represents a new private-public partnership arrangement for financing and maintenance.

Before the architecture firms got involved, the hospital went through a functional planning process that included a redevelopment plan for the 10.5-acre site done by Toronto-based Urban Strategies. The team of Stantec Architecture (Edmonton, Alberta, Canada) and KPMB Architects (Toronto) came on board next as the planning, design, and compliance architects for Bridgepoint. They were responsible for the project-specific outline specifications and the “design exemplar,” a prescriptive plan approved by the Ministry of Health that was executed by a design, build, finance, and maintain (DBFM) consortium, which included HDR Architecture and Diamond Schmitt Architects as the architects-of-record.

History lessonThe site of the new hospital has played an important role in Toronto’s evolution since the 1860s, when the Don Jail and House of Refuge were built. Separated from the city center and surrounded by nature, this setting was thought to be conducive to the health and wellbeing of prisoners and patients alike. For many years, the land functioned as an independent campus, complete with staff residences and a working farm that harvested crops and raised livestock.

The Don Jail, the largest building project Toronto had seen to date, was conceived of as a progressive reform institution, where prisoners would have a balance of work, exercise, education, socialization, and solitary time for contemplation. The House of Refuge was built as a place to shelter Toronto’s “poor, needy, and disabled,” and was converted in the 1870s to an isolation hospital responding an outbreak of smallpox and later of other infectious diseases. The hospital evolved many times, acting as a medical training center, a provincial center for HIV/AIDS care, and finally rebranding as Bridgepoint Health, which was founded in 2002 to address the increasingly important issue of complex chronic disease.

The new Bridgepoint Hospital responds to an urgent need that the old hospital could no longer address: increasing demand for increasingly complex healthcare. “This is the new frontier of healthcare,” says Marian Walsh, CEO, Bridgepoint Active Healthcare. “One hundred years ago, people died young, of quick, communicable diseases. We eradicated communicable diseases and turned our attention to human biology—diagnosing and fixing things when they go wrong. The new challenge of modern medicine is managing people living with multiple conditions.”

In fact, as Walsh points out, one of every two Canadians is living with an underlying major condition, and the number of individuals who require ongoing complex care will only increase with projected population increases. And she managed to convince the government of Ontario and policy makers that developing facilities designed to meet the needs of those with chronic complex conditions was the right strategy.

LocationBridgepoint’s leaders envisioned a new kind of healthcare in a new kind of hospital: a civic building, an urban place, and a place for healthcare and community to come together. In such a place, patients could rediscover their sense of self at their own pace, participate in the city and their community, engage the world around them, and prepare to return home. The location of the site allowed for the design to be fully integrated into the natural green spaces and systems of the Don River Valley and Riverdale Park, as well as the vibrant, diverse urban fabric of the adjacent Riverdale neighborhood.

According to Bruce Kuwabara, principal, KPMB Architects (Toronto), the site is “part of the epic history of the narrative of the city of Toronto. The Riverdale Park setting has always been associated with being removed but having a connection to the city,” he says, adding that many organizations have tried to reclaim the Don Valley as a community space.

The site is laid out in a nine-square grid, with the Old Don Jail as the centerpiece. To get approval for the new hospital, Bridgepoint had to agree to preserve the historic buildings on the site and create an adjacent park. A restoration and adaptive reuse plan transformed the 1864 jail building into new administration offices for the hospital. The Governor of the Jail’s house also remains, housing a children’s palliative care facility. Buildings occupying other parts of the grid include the old hospital and two other jail buildings, all of which will eventually be torn down.

“Out of those nine squares, only two of them could be used for the new building,” says Greg Colucci, principal, Diamond Schmitt Architects (Toronto). “So, there were logistical constraints but spectacular opportunities to connect patients to nature and connect the community to patients.”

And public access to the Old Don Jail gives local residents and tourists an opportunity for the first time to explore the building. When KPMB’s Kuwabara was a kid, his grandmother lived near the site. “She always told us to play in the park, but not go near the jail or the hospital,” he says. “We always used to go near the jail anyway. Now that it’s open to the public, it’s one of the greatest local attractions.”

Located on high ground, overlooking the Don Valley Parkway, and surrounded by parkland, the new Bridgepoint facility occupies a point of considerable regional prominence. Hundreds of thousands of commuters see it every day, and, for many, it marks an entry point to downtown Toronto. Also, because of its context, tall buildings will never dominate the new Bridgepoint.

“The building is designed with floor-to-ceiling glass in many places,” says Bridgepoint’s Walsh. “The idea is that patients and staff should be able to see through the building to the outside—the community—and feel connected to the outside world all the time.”

Step insideUnlike the old hospital, which had wards, the new facility has single- and double-bed rooms, each with window sill heights that are less than 3 feet, accommodating large horizontal windows. “At the time this facility was programmed, the standard in Canada was different,” says Tod Trigg, senior project manager, HDR Architecture (Omaha, Neb.). “But because these patients aren’t acute, it isn’t as necessary to have single-bed rooms. Double-bed rooms helps with socialization and is part of the therapy process.”

Every room has at least one pop-out window—a 9-foot vertical floor-to-ceiling window that steps out from the building about 2 feet. In fact, there’s one pop-out window for every one of the 464 patient beds in the facility. On the exterior, the windows, which are flanked with metal cladding, project as boxes and create varying colors and sh
adows, depending on the weather and time of day.

To save cost and create a “beltline” to break up the vertical mass of the building, mechanical systems were moved to the middle. KPMB’s Kuwabara describes it as a “stagger and swagger” design with cantilevers and the building broken into large boxes with bay windows at the end where the patient lounges are located.

Non-patient room space is in the center on each of the eight patient floors, with communal dining and rehabilitative recreation spaces for patients, and multipurpose meeting and teaching rooms for staff. Six nurses’ stations are distributed on each patient floor to provide easy access to patient rooms and other areas.

In keeping with salutogenic principles that seek to address individuals’ psychosocial well-being, architectural details, textures, and finishes in the new Bridgepoint facility were chosen to de-emphasize the feeling of being in an institution and provide cues signifying comfort and community. Color schemes and floor patterning provide clear wayfinding, with green used to the north (corresponding to Riverdale Park), neutral tones in the middle zone, and blue to the south (corresponding to the lake). Floor plans facilitate multiple and frequent interior view corridors and views of the exterior; close adjacency to centralized therapy spaces, elevators, and stairs; and give the impression of small floor plates, providing a sense of intimacy and orientation.

Step outsideA barrier-free therapy pool references the minimalist characteristics of contemporary resort and spa design to create a safe, inviting, recreational impression. Located at the north end of the ground floor, the pool features full-height glazing that offers bright natural light and views to Riverdale Park.

The ground floor of the new hospital is a publicly accessible “urban porch” with a Tim Horton’s restaurant, drug store, multipurpose auditorium, library, and access to two outdoor terraces. The porch encourages different kinds of gathering and interaction, providing a range of positions, vantage points, supports, paths, and types of seating from which patients can observe and participate in community life. The glazing system brings natural light through the entrances, vestibules, and lobbies of the porch, and natural materials such as wood, stone, and water help integrate the building into the landscape and deinstitutionalize the atmosphere to reinforce the goals of wellness and community-building.

The entire site has been designed with barrier-free access, five-degree ramps, gentle stairs, and sightlines to facilitate wayfinding and encourage circulation. Planting consists of 100 percent indigenous species and has been chosen to represent a range of colors and flowering sequences throughout the seasons. Courtyards at different grades, each with a character of its own, provide patients and visitors with places to rest in solitude or to meet in groups.

A barrier-free labyrinth, sited at the threshold between the hospital and the park, acts as a space for ambulatory therapy, meditative reflection, and as a destination for public events. The publicly accessible space encourages patients to interact with the community, and patients can benefit even in their rooms by observing those walking below.

“Because patients stay so long, the ability to get them out of the building is important,” says Stantec’s Elgie. “When we arrived for meetings at the old hospital, there was always a crowd of patients there to greet us. We realized they were there because they were getting better.”

The main entrance of the hospital—the Civic Court—creates a welcoming front door for Bridgepoint and a transitional space that integrates the hospital with the community. It was designed for patients, visitors, staff, and the public to gather, exercise, relax, meditate, and watch people and vehicles come and go. “There aren’t many hospitals that are designed as public buildings where you feel like you can take a short cut through them or use their spaces,” HDR’s McClean says. “Marian Walsh didn’t want to re-create just another institutional building, but rather one that would change the way Bridgepoint was able to deliver healthcare.”

A fifth-floor Sky Garden terrace is contained and intimate—a place to meditate and view the city. The 10th floor green roof is much larger in scale and serves a place to amble and interact.

Looking back, and forwardMembers of the four different architectural firms involved in the project agree that the process, although complex and not perfect, was successful. “Bridgepoint got what it wanted—a building that represents the vision and quality of care it wanted to achieve for the new direction that healthcare is going,” Stantec’s Elgie says.

For Bridgepoint’s Walsh, the process was challenging—in more ways than one. First, they had to convince the Ministry that this was the right type of building to build. Then they had to make the business case for adding amenities like landscaping. Next, they had to assemble the land and get the buy-in of the local community. Finally, they had to work with a whole new procurement process and method of financing.

In order to evaluate the actual performance of the new facility against project objectives, an independent group called the Bridgepoint Research Collaboratory will compare a range of data collected from the old Bridgepoint hospital with data from the new facility, and in turn with that of a third-party reference facility. The potential impact of this research is three-fold: It will be used to adapt and improve Bridgepoint on an ongoing basis, it will contribute knowledge to a growing body of international research on healthcare design, and it will set new standards for best practices in the field design evaluation methodology itself.

“Our commitment is to provide great care [for people with complex chronic conditions] and we also want to be Canada’s leading organization in this area,” Walsh says. “Not just provide the care, but develop the evidence that will support improvements in how we organize and deliver care to this population so that we’ll have a sustainable future.”

Sara O. Marberry, EDAC, is a contributing editor for Healthcare Design. She is a writer, blogger, speaker, and strategic marketing and business consultant in Evanston, Ill., and the former executive vice president of The Center for Health Design. She can be reached at sara@saramarberry.com.

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